COVID-19 in the Nation’s Nursing Homes

Finance: A National Tragedy: COVID-19 in the Nation’s Nursing Homes, March 17, 2021

I will not pull any punches.

This crisis is worse than you think. For whatever reason, the Coronavirus Task Force has ignored the first round of symptoms of this ailment. In my experience, it begins as a cold with heavy mucus. Bad timing made many sufferers believe that they had merely suffering from hay fever. There is then a week of dormancy. If you assume that exposure occurs two weeks prior to the first symptoms, there are four weeks, rather than two, before SARS symptoms are manifested, including fever, fatigue from low oxygen levels and fatigue from the manufacture of immunity (which feels like a gut punch over a two-week period).

Ignoring the early symptoms in CDC guidelines means that, even with the best of care, the pandemic can blow through the nursing population before anyone realizes that COVID is running amok. The continuing denial of this model means that the disease will continue unabated until it runs out of vectors - meaning that vulnerable patients will continue to die until vaccinated.

On the positive side, our experience is that once one has marked symptoms), full immunity is most likely. Young people, who laughed off the early symptoms of the virus or simply did not experience it, are now getting sick. This could lead to another round of reinfection in nursing homes staffed with younger workers. Older workers, who likely have had symptoms, are now safer care givers for the elderly. 

One of the developments no one talks about is the shedding of PPE. Healthcare workers see patients when they are after the contagious stage. Heavy PPE frightened people with the virus in the first wave had them avoid care until it was too late. Publicizing this will get people into care faster. Fearing death becomes a self-fulfilling prophecy when care given early will save lives. 

Getting nursing home patients into a hospital setting will preserve their lives. Leaving their care to nursing home staff, especially when the disease is first evident, means that residents will get care from rookies. This is not a disease that tolerates mistakes in care.

COVID mortality has hastened death for older victims. Those who would have died of a heart attack within the next five years likely died this past year.  We will see how high COVID deaths reach in comparison to heart attack death for the year. I suspect the latter will be down and the former may be second to cancer, if not the number one cause of death this year.

In comments provided to congressional committees last summer, I predicted at least 120 deaths per 100,ooo individuals in the population. I had assumed that the nation would have done better than New York, which at the time had 150 deaths per 100,000. If mortality mirrors New York from that period, 500,000 people would have died. We have exceeded the more pessimistic estimate by tens of thousands. 

Careful chart review will likely show under-reporting, so true death rates may turn out to approach 1,000,000 deaths. Let this sink in for a moment. 

This virus originally did not hurt younger people. The latest variant is now making them very ill, but is less likely to kill them. By the time vaccines arae available to them, they will have already been ill. 

The science is now showing that children have more robust immune systems. To them, COVID-19 is just another cold virus to fight off. Their immune systems are in high gear. For this reason, vaccinating them will be a mistake. They need to build their immune systems by getting sick and recovering. Robbing them of this experience leaves them vulnerable to the next pandemic. They need to play in the dirt and with each other, even when sick. Colds are not ebola. Treating it as such is counter-survival for the species. 

Why were older people more vulnerable at first? Older citizens are farther away from having colds and being exposed to them. Current precautions also degrade immunity because it is not challenged. This is also why Influenza is so dangerous to nursing home residents. Older citizens who are not in a nursing home, especially those in a multi-generational household, are less likely to become sick, primarily because their immune systems are challenged by their snot-nosed grandchildren. 

Any parent will confirm that their younger children are constantly sick and that they share the pain – much to the horror of co-workers – although having sick parents come to work also spreads manageable illness. Being shielded, however, leaves one vulnerable to symptoms. My daughter is with her mother in Knoxville. I got sick. My ex-wife probably will not, especially as she has just had her second shot.

A major problem in getting care is our insurance system. A single-payer system, either through a public option, Medicare for All or cooperative care through employee-owned and provided medicine, including nursing homes, will save lives in the next pandemic. 

The attachment presented in 2019 is still as timely as it was then. Even more so, since it covers the public option within the Affordable Care and American Recovery Acts. If pre-existing conditions were repealed, for profit insurance would move more people to the public option each year, which would be their undoing. Single-payer health care as part of a bailout of the industry would be the natural result.

A recent paper by the National Bureau of Economic Research asking “Does Private Equity Investment in Healthcare Benefit Patients? Evidence from Nursing Homes” is essential in addressing this issue. I commend it to your attention. You can find it online at https://www.nber.org/papers/w28474  

Attachment: Single Payer